TRUTH AFFIDAVIT

IN THE NATURE OF SUPPLEMENTAL RULES FOR ADMINISTRATIVE

AND MARITIME CLAIMS RULES C(6)
Grant of exclusive power of attorney to conduct all
tax, business, and legal affairs of principal person.

POWER OF ATTORNEY IN FACT

I, FIRST M LAST, FIRST MIDDLE LAST, LAST, FIRST M.., or any derivative thereof,
DEBTOR / CORPORATE FICTION, 1234 BIRTH HOSPITAL ADDRESS, CITY, ST,
54321, do hereby appoint First Middle Last, a Living Soul / Secured Party Creditor, as Agent
with Power of Attorney in Fact, Non-domestic, c/o 1234 Your Address Street, City, State
Republic [54321], to take exclusive charge of, manage, and conduct all of my tax, business, and
legal affairs, and for such purpose to act for me in my name and place, without limitation on the
powers necessary to carry out this exclusive purpose of attorney in fact as authorized:
(a) To take possession of, hold, and manage my real estate and all other property;
(b) To receive money or property paid or delivered to me from any source;
(c) To deposit funds in, make withdrawals from, or sign checks or drafts against any
account standing in my name individually or jointly in any bank or other depository,
to cash coupons, bonds or certificates of deposits, to endorse checks, notes, or other
documents in my name; to have access to, and place items in or remove them from
any safety deposit box standing in my name individually or jointly, and otherwise to
conduct bank transactions or business for me in my name;
(d) To pay my just debts and expenses, including reasonable expenses incurred by my
attorney in fact, First Middle Last, in exercising this exclusive power of attorney;
(e) To retain any investments, invest, and to invest in stocks, bonds, or other securities,
or in real estate or other property;
(f) To give general and special proxies or exercise rights of conversion or rights with
respect to shares or securities, to deposit shares or securities with, or transfer them to
protective committees or similar bodies, to join any reorganization and pay
assessments or subscriptions called for in connection with shares or securities;
(g) To sell, exchange, lease, give options, and make contracts concerning real estate or
other property for such considerations and on such terms as my attorney in fact, First
Middle Last, may consider prudent;
(h) To improve or develop real estate, to construct, alter, or repair building structures and
appurtenances or real estate; to settle boundary lines, easements, and other rights with
respect to real estate; to plant, cultivate, harvest, and sell or otherwise dispose of
crops and timber, and do all things necessary or appropriate to good husbandry;
(i) To provide for the use, maintenance, repair, security, or storage of my tangible
property;
(j) To purchase and maintain such policies of insurance against liability, fire, casualty, or
other risks my attorney in fact, First Middle Last, may consider prudent.

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The Agent / Living Soul / Secured Party / Creditor, First Middle Last, is hereby authorized by
law to act for and in control of the DEBTOR / CORPORATE FICTION, FIRST MIDDLE
LAST, or any derivative thereof. In addition, through the exclusive power of attorney, Agent is
authorized to contract for all business and legal affairs of the principal person: LAST, FIRST M.,
DEBTOR / CORPORATE FICTION.
The term “exclusive” shall be construed to mean that while these powers of attorney are in force,
only my attorney in fact may obligate me to these matters, and I forfeit the capacity to obligate
myself with regard to the same. The grant of Exclusive Power is irrevocable during the lifetime
of the Agent/Living Soul, First Middle Last.

Executed and sealed by the voluntary act of my own hand on this _____ day of Month, 2021.
This instrument was prepared by First Middle Last.
Acceptance:
FIRST M. LAST, GRANTOR
DEBTOR SIGNATURE

Executed without the UNITED STATES, I declare under penalty of perjury under the laws of the
united states of America that the foregoing is true and correct.
Without prejudice, U.C.C. § 1-308.

I, the above named, exclusive attorney in fact,

do hereby accept the fiduciary interest of the
herein-named CORPORATE FICTION and will execute
the herein-granted powers-of-attorney with due diligence.

______________________________________

First Middle Last, Agent,

Attorney in Fact, with the Autograph

Witnesses

________________________ ________________________ ________________________

________________________ ________________________ ________________________

________________________ ________________________ ________________________

Notice
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Using a notary on this document does not constitute any adhesion, nor does it alter my status in
any manner. The purpose for notarization is verification and identification only and not for
entrance into any foreign jurisdiction.

Jurat

Your County ]
] ss:
State Republic ]

Subscribed and affirmed before me this ______ day of Month, 2021.

__________________________________________

Notary

Notary Seal:

My commission expires: ________________